TABLE 4.

Doses, Indications, Dose Modifications, Contraindications, Cautions, and Adverse Effects of GLP-1RAs With Demonstrated CV Benefit

	Dulaglutide	Exenatide QW	Liraglutide	Lixisenatide	Semaglutide SC	Semaglutide PO
Recommended doses for CV benefit	■ Initiate 0.75 mg SC per week ■ Titrate slowly to 1.5 mg or maximally tolerated dose based on prescribing information.	■ 2 mg SC per week	■ Initiate 0.6 mg SC daily. ■ Titrate slowly to 1.8 mg or maximally tolerated dose based on prescribing information.	■ 10 mcg SC daily ■ Titrate as tolerated to 20 mcg daily based on prescribing information.	■ Initiate 0.25 mg SC per week. ■ Titrate slowly to 1 mg once weekly or maximally tolerated dose based on prescribing information.	■ Initiate 3 mg PO per day for the first 30 days. ■ Titrate slowly to 14 mg daily or maximally tolerated dose based on prescribing information.
Indications	■ Improve glycemic control in adults with T2D. ■ Reduce MACE for people with T2D with and without established CV disease.	■ Improve glycemic control in adults with T2D.	■ Improve glycemic control in adults with T2D. ■ Reduce risk of MI, CVA, or CV death in adults with T2D and CV disease.	■ Improve glycemic control in adults with T2D.	■ Improve glycemic control in adults with T2D. ■ Reduce risk of MI, CVA, or CV death in adults with T2D and CV disease.	■ Improve glycemic control in adults with T2D.
Dose modifications	■ Up-titrate slowly to reduce nausea and vomiting. ■ Discontinue if pancreatitis is suspected and do not restart if pancreatitis is confirmed. ■ No dose adjustment necessary with renal or hepatic impairment; data in end-stage renal disease are limited.	■ Discontinue if pancreatitis is suspected and do not restart if pancreatitis is confirmed. ■ eGFR <45 mL/min/1.73 m2: Use is not recommended.	■ Up-titrate slowly to reduce nausea and vomiting. ■ Discontinue if pancreatitis is suspected and do not restart if pancreatitis is confirmed. ■ No dose adjustment is necessary with renal or hepatic impairment.	■ Up-titrate slowly to reduce nausea and vomiting. ■ Discontinue if pancreatitis is suspected, and do not restart if pancreatitis is confirmed . ■ eGFR ≥30 mL/min/1.73 m2: No dosage adjustment is required. ■ eGFR 15 to 29 mL/min/1.73 m2: Use caution and monitor renal function. ■ eGFR <15 mL/min/1.73 m2: Use is not recommended.	■ Up-titrate slowly to reduce nausea and vomiting. ■ Discontinue if pancreatitis is suspected and do not restart if pancreatitis is confirmed. ■ No dose adjustment is necessary with renal or hepatic impairment.	■ Up-titrate slowly to reduce nausea and vomiting. ■ Discontinue if pancreatitis is suspected and do not restart if pancreatitis is confirmed. ■ No dose adjustment is necessary with renal or hepatic impairment.
Contraindications	■ History of serious hypersensitivity reaction to drug ■ Pregnancy or breast feeding ■ Severe renal impairment or end-stage renal failure (exenatide, lixisenatide) ■ Personal or family history of medullary thyroid cancer ■ Personal or family history of MEN2
Cautions	■ Hypoglycemia risk increased with insulin, sulfonylureas, or glinides. ■ May delay gastric emptying; not recommended in patients with clinically meaningful gastroparesis. This effect is usually transient with longer-acting GLP-1Ras. ■ Care should be taken in patients with prior gastric surgery, including bariatric surgery. ■ Diabetic retinopathy complications were reported with semaglutide (injectable), although it is unclear if this is a direct effect of the drug or due to other factors such as rapid improvement in blood glucose control.
Adverse effects to monitor	■ Nausea, vomiting, diarrhea, headache, weakness,or dizziness ■ Hypoglycemia when given with insulin, sulfonylureas, or glinides. ■ Weight loss ■ Injection site reactions

CV = cardiovascular; CVA = cerebrovascular accident; eGFR = estimated glomerular filtration rate; GLP-1RA = glucagon-like peptide-1 receptor agonist; MACE = major adverse cardiovascular events; MEN2 = multiple endocrine neoplasia, type 2; MI = myocardial infarction; PO = “per os,” by mouth; QW = once weekly; SC = subcutaneous; T2D = type 2 diabetes.